As a physical therapist with expertise in vestibular therapy, I often hear stories like this:
“I woke up super early in the morning and felt off. When I rolled over and tried to get out of bed, the whole room started to spin. Eventually it settled down enough that I was able to get up and walk to the bathroom, but ever since then, I get dizzy if I look up/down and I definitely can’t sleep on my side or I’ll get really dizzy again.”
While every person’s experience is different, stories like this are common among people dealing with dizziness or vertigo. If it sounds familiar, you’re not alone. The good news is that many causes of dizziness are treatable, and vestibular physical therapy can often help identify what is happening and guide the right treatment.
What is the difference between dizziness & vertigo?
People often use dizziness and vertigo as if they mean the same thing, but they are not identical. Dizziness is a general term used by many people to describe their feelings of:
- imbalance
- spinning
- vertigo
- lightheadedness
- spaciness
- “just feeling off”
Vertigo is actually a specific type of dizziness. If you have vertigo, you feel like you are (or the space around you is) spinning, rocking or swaying, when no motion is actually occurring.
That distinction is important because the type of sensation you experience gives your physical therapist valuable clues about the underlying cause.
Why am I dizzy?
Dizziness happens because three sensory systems in your body are all simultaneously giving your brain information about how your head is moving:
- Inner ear (vestibular system)
- Eyes (visual system)
- Joints (proprioceptive system)
If any one of these three systems gives you faulty information, it can take your brain time to determine which system(s) input it should be listening to and which it should ignore. Until it sorts out which information is reliable, you may feel dizzy, off balance or disoriented.
What type of dizziness you feel, and what brings it on, can give your physical therapist or other health care provider valuable insight as to what is causing the problem.
There are many potential causes for the dizziness you feel. Common causes of dizziness include:
- Conditions that affect the inner ear
- Dehydration
- Medication side effects
- Migraines or cervicogenic dizziness
- Concussions
Less common conditions include stroke/circulatory issues, hormone/vitamin imbalances, tumor, etc. While some of these conditions are relatively uncommon, they are serious.
When should I seek medical attention?
You should seek immediate medical attention if you have a sudden onset of dizziness associated with:
- sudden chest pain
- irregular heartbeat
- loss of sensation or movement in your face, arm or leg
- difficulty breathing
- seizures
- slurred speech
- confusion
For the more common and less serious causes, a physical therapist may be your first point of contact and can help guide you in the right direction for treatment.
What is BPPV (Benign Paroxysmal Positional Vertigo)?
Specifically, for vertigo, the most common cause is BPPV (Benign Paroxysmal Positional Vertigo). People often refer to this type of vertigo as positional vertigo.
If you are getting vertigo when you first lie down in bed, first wake up in the morning, when you roll over, or when you do something like look up at a high shelf, and the vertigo lasts for a few seconds to a minute, you likely have BPPV.
This can be treated by a physical therapist specially trained to treat vestibular disorders.
What causes BPPV?
It may sound silly, but you have what most people call crystals (otoliths) in your inner ear. Sometimes, these crystals can move from where they are supposed to lie, into your inner ear canals. When this happens, they interfere with your inner ear’s ability to send accurate sensory information to your brain.
How does PT help with BBPV?
A physical therapist can guide you through a series of movements that, in essence, roll the crystals back out of the canal. The most well-known movement series is called the Epley Maneuver; however, there are several different maneuvers, and which one will work best for you will be determined during an evaluation.
In all honesty, BPPV symptoms will resolve on their own given enough time. Spontaneous remissions do occur, as do recurrences. But, there is no way to know how much time it will take for symptoms to subside on their own and, with the proper repositioning maneuvers, it often takes just a few visits (even just one) to resolve symptoms!
What are other common causes of dizziness and vertigo?
There are other common causes of vertigo that differ from BPPV in that the vertigo is not positionally based, and it can last for hours, days or weeks depending on the cause. These diagnoses include things such as:
- Vestibular neuritis: typically, a viral infection that affects the vestibular nerve and is often preceded by a sinus, chest or GI infection.
- Meniere’s Disease: also associated with feelings of fullness in the ears, tinnitus, and hearing loss.
- Vestibular migraines: migraines that often lack the typical pain headache with the predominate symptom being dizziness.
Physical therapy is an important part of treatment for many of these conditions, particularly when dizziness, imbalance or motion sensitivity persists after the initial medical management.
What will I do in physical therapy?
As you have figured out, there are a lot of different potential reasons for dizziness.
Because dizziness can have many different causes, the evaluation is the most important first step.
A vestibular physical therapist will typically assess:
- your symptom history
- eye movements (oculomotor testing)
- vestibular function
- balance and walking
- neck mobility and posture
- movement patterns that provoke symptoms
If you have BPPV
Treatment focuses on repositioning maneuvers such as the Epley maneuver to move the displaced crystals out of the affected canal.
If your dizziness has another cause
Treatment may include:
- gaze stabilization exercises
- balance training
- habituation exercises to reduce motion sensitivity
- postural stability training
- walking and functional movement practice
- education about symptom management
If dizziness is related to migraine, concussion or neck dysfunction, treatment may also include more traditional orthopedic physical therapy to address cervical mobility, muscle tension and postural impairments.
Does dizziness increase your risk of falling?
Yes. Problems involving the vestibular system can significantly affect balance and equilibrium.
This is especially important for older adults, where a fall may result in serious injury, but younger individuals can also experience enough dizziness to make walking, turning or changing positions unsafe.
Vestibular rehabilitation helps by improving:
- balance reactions
- coordination
- walking stability
- confidence with movement
- strength needed to recover from a loss of balance
Research has shown that targeted balance and vestibular exercises can help reduce fall risk and improve long-term mobility.
FAQs about dizziness and vertigo
What is vertigo?
Vertigo is a specific type of dizziness. If you have vertigo, you feel like you are (or the space around you is) spinning, rocking or swaying, when no motion is actually occurring.
What causes dizziness when rolling over in bed?
The most common cause is BPPV, where displaced inner ear crystals trigger brief episodes of vertigo when the head changes position.
Can dizziness go away on its own?
Some conditions, including BPPV, may improve without treatment. However, symptoms can persist for an unpredictable amount of time, and treatment often helps people recover more quickly and safely.
Should I see a doctor or a physical therapist for dizziness?
If you have emergency warning signs such as weakness, slurred speech, chest pain or difficulty breathing, seek immediate medical care.
For dizziness related to position changes, balance problems, motion sensitivity or persistent vertigo, a vestibular physical therapist can often evaluate the problem and help determine the appropriate next steps for treatment or referral.
What are common causes of dizziness that physical therapists treat?
BPPV, Vestibular neuritis, Vestibular hypofunction, Meniere’s Disease, vestibular migraines, concussions, cervicogenic dizziness to name a few.
How can physical therapy help with dizziness?
Treatment tends to focus on improving balance strategies, gaze stabilization training, habituation exercises, and lots of patient education. If you are diagnosed with BPPV, treatment will also include repositioning maneuvers.
The bottom line about dizziness
If the story at the beginning of this article sounded familiar, don’t ignore it.
Whether your symptoms are caused by BPPV, a vestibular disorder, migraine, concussion or another condition, the first step is getting an accurate diagnosis.
A vestibular physical therapist can identify the likely source of your dizziness, explain what is happening and create a personalized treatment plan to help you return to walking, sleeping, driving, working and moving through daily life with greater confidence and less fear of another dizzy episode.
